“Grey’s Anatomy” Character Highlights Phantom Limb Pain

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Grey’s Anatomy character Dr. Arizona Robbins, played by actress Jessica Capshaw, has had a rough year.

Although she survived a plane crash which killed two other physicians, the pediatric surgeon had a terrible leg wound, which ultimately lead to a leg amputation. And just as things started to look up for Arizona -she’s accepted a prosthetic limb and returned to work, she’s been plagued by another problem- phantom limb pain. As Dr. Meredith Grey (Ellen Pompeo) says in her opening voice-over:

Patients who undergo amputation often feel sensation where the missing limb was, as if it’s still there. The syndrome is called phantom limb. It’s as if the body can’t accept that a terrible trauma has occurred. The mind is trying to make the body complete again. Patients who experience phantom limb report many different sensations, but by far the most common is…pain.

At one point, the pain is so severe that Arizona asks assistant surgeon, Alex Karev, to stab her in the prosthetic foot to relieve the pain. She eventually confides to surgical chief Owen Hunt (Kevin McKidd) that she thinks she is going crazy, but he recognizes the problem from his military service and will help her find therapies that may make things easier.

What is phantom limb pain?

figfive1After a limb is amputated, a patient may feel as if the limb is still there. This is called phantom sensation. It may feel:

  • Tingly
  • Prickly
  • Numb
  • Hot or cold
  • Like the missing toes or fingers are moving
  • Like the missing limb is still there, or is in a funny position
  • Like the missing limb is getting shorter. This is called telescoping.

Pain in the missing part of the arm or leg is called phantom pain. It may feel like sharp or shooting pain, achiness, burning pain or muscle cramping.

It is estimated that between 60-80% of patients who have experience an amputation experience phantom sensations in their amputated limb, and the majority of the sensations are painful.

What causes phantom limb pain?

Theories concerning the cause of phantom limb pain (PLP)  have evolved over time. PLP was initially thought to be a psychological problem related to the psychic trauma of limb loss. Later theories asserted that the pain was real, but was probably related to changes which originated at the site of the amputation. Irritation of the severed nerve endings, called neuromas, sent abnormal signals to the brain which were interpreted as pain. This sometimes lead to surgery to revise the stump in the hope of eliminating the pain, which was often unsuccessful.

More recent research confirms that PLP are real sensations, but that their origins are in the brain. Using studies in primates and noninvasive imaging techniques such as MEG (magnetoencephalogram) and functional MRI, researchers now believe that PLP sensations are due to the brain’s attempt to reorganize sensory information following the amputation. The brain is “rewiring itself” to adjust to the body change. This is referred to as central nervous system plasticity. Unfortunately, in PLP, this “rewiring” hasn’t gone quite right, causing the associated symptoms.

What is the course of phantom limb pain?

Phantom sensations typically get weaker and happen less frequently slowly over time. Although phantom limb pain will lessen over time for most people, they may not ever go away completely.

How is phantom limb pain treated?

Finding a treatment for PLP can be difficult. There is no specific medication to treat it, although some medications, such as antidepressants, anticonvulsants and some narcotics may decrease symptoms.

Some noninvasive therapies have also become available:

  • Transcutaneous electrical nerve stimulation (TENS): a device sends a weak electrical current across the skin near the area of pain using adhesive patches on the skin.
  • An artificial limb called a myoelectric prosthesis
  • A mirror box: developed by Vilayanur Ramachandran and colleagues, uses a mirror to create artificial visual feedback. Looking into the box, the patient becomes able to “move” the phantom limb, and to unclench it from potentially painful positions. Repeated training in some subjects has led to long-term improvement. Here’s a video to show how it works:

Recently, graded motor imagery (which may incorporate mirror therapy) and sensory discrimination training have emerged as promising therapeutic tools in dealing with pathological pain problems such as phantom limb pain and complex regional pain syndrome.

Why do a blog about a fictional character?

Although Arizona Robbins may be fictional, the issue she is dealing with is very real, and very important.

Just think about how many servicemen and women have sustained injuries that required amputation over the past eleven years.  According to the Armed Forces Health Surveillance Center, from 2000 to 2011, there were 6,144 cases of traumatic amputations among 5,694 service members. And according to  Army Times , the Department of Defense reported that the number of U.S. troops who lost limbs reached a wartime high in 2011.

And this doesn’t even scratch the surface on the potential magnitude of the problem- what about those who have had amputations because of accidental trauma, diabetes, heart disease. infection or cancer?

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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